UCT O&G Refresher Course
CTG Workshop Registration Form
(11, 15, 18, 20 &26 November 2019: Groote Schuur Hospital)

To register, kindly complete one form per delegate.

DELEGATE INFORMATION

*Title: *Last Name:
*First Name:
(for badge)
Middle Name:
Nationality: Gender:
MP Number:
Do you agree that your name and email address can be given to sponsors of the congress: Yes / No
*Organisation/Institute/Trust: *Position:
This is my:
(please select)
Private / Institution    
Address: City:
State/Province: ZIP/Post Code:
Country:
Work/Business Telephone Number:
(Country code/city code/number)
Fax:
(Country code/city code/number)
*E-Mail: *Verify E-Mail:
Mobile/Cell Number:
Special Dietary Requests: All meals provided are Halaal. Kosher meals can be arranged at an extra cost (price on application).
Vegetarian: Yes / No / Other If other, specify:
Other Requests
Other Special Requests:
(Please specify any access needs you have e.g. wheelchair user, mobility difficulties, hearing impaired etc.)
   

*Compulsory fields.

REGISTRATION FEES: CTG WORKSHOP

Registration Fees - South African Rand (ZAR) Only (includes VAT)

Registration Category
Cost
(Per day)
No. of
People
Amount
(ZAR)
Consultants Registration
750
Registrars, Medical Officers & Nursing Staff Registration
550
Please indicate the date you would like to attend by ticking the box applicable:
Monday, 11 November 2019
   
Friday, 15 November 2019
   
Monday, 18 November 2019
   
Wednesday, 20 November 2019
   
Tuesday, 26 November 2019
FULLY BOOKED
   
TOTAL: Registration Fees - CTG Workshop

Registration fees Include: Attendance at the workshop on the specific day your register for, tea breaks, lunch, a name tag and a printed programme.

TOTAL AMOUNT PAYABLE

GRAND TOTAL: Registration Fees - CTG Workshop

PAYMENT DETAILS

Please select your payment option below.

Option 1
Bank Transfer
You must specify your full name and UCT CTG Workshop on your bank transfer. Forward to:
Account Name:Turners Conferences & Conventions Pty Ltd - UCT CTG Workshop
Bank:First National Bank
Account No.:62766694634
Branch:
Branch Code:250655
Swift No.:FIRNAJJ
(Please fax a copy of your transfer to Turners Conferences +27 31 368 6623)
Final date for Bank Transfer payments will be the 2 July 2019.
All fees associated with Forex payments are for your own account. Please instruct your bank accordingly when processing payment.
Option 2
Credit Card
When opting to process payment by credit card, further instructions will be emailed advising on how to process payment via the online 3D PayGate Portal. A unique reference number will be issued to you.

Please complete this booking form and submit it to the Turners Conferences:

Turners Conferences and Conventions (Pty) Ltd
PO Box 1935, Durban, 4000 South Africa
Telephone: +27 31 368 8000
Fax: +27 31 368 6623
Email: leannea@turnersconferences.co.za

All transactions are conducted in terms of Turners Conferences standard conditions of trading. They are published on the Turners Conferences website & available on application.
Without the complete documents, we are unable to process your booking.

Your booking will only be confirmed once payment has been received.

All published prices are subject to change without prior notice. This may be due to currency regulations and/or changes in duties or taxes.

Type this number into the box alongside: